TANYA'S

COMPREHENSIVE GUIDE TO

FELINE CHRONIC KIDNEY DISEASE

 

 

WORKING WITH YOUR VET

 

ON THIS PAGE:


The Importance of a Good Vet


Working Together


If Your Vet Refuses to Assist


Choosing a Vet


A Specialist Vet Or A General Vet


A Second Opinion


Recordkeeping


 

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WHAT IS CKD?


What Happens in CKD


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How Bad is It?


Is There Any Hope?


Acute Kidney Injury


 

KEY ISSUES


Nausea, Vomiting, Appetite Loss and Excess Stomach Acid


Maintaining Hydration


The Importance of Phosphorus Control


All About Hypertension


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Potassium Imbalances


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SUPPORT


Coping with CKD


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SYMPTOMS


Alphabetical List of Symptoms and Treatments


Fluid and Urinary  Imbalances (Dehydration, Overhydration and Urinary Issues)


Waste Product Regulation Imbalances (Vomiting, Appetite Loss, Excess Stomach Acid, Gastro-intestinal Problems, Mouth Ulcers Etc.)


Phosphorus and Calcium Imbalances


Miscellaneous Symptoms (Pain, Hiding Etc.)


 

DIAGNOSIS: WHAT DO ALL THE TEST RESULTS MEAN?


Blood Chemistry: Kidney Function, Potassium, Other Tests (ALT, Amylase, (Cholesterol, Etc.)


Calcium, Phosphorus, Parathyroid Hormone (PTH) and Secondary Hyperparathyroidism


Complete Blood Count (CBC): Red and White Blood Cells: Anaemia and Infection


Urinalysis (Urine Tests)


Other Tests: Ultrasound, Biopsy, X-rays etc.


Renomegaly (Enlarged Kidneys)


Which Tests to Have and Frequency of Testing


Factors that Affect Test Results


Normal Ranges


International and US Measuring Systems


 

TREATMENTS


Which Treatments are Essential


Fluid and Urinary Issues (Fluid Retention, Infections, Incontinence, Proteinuria)


Waste Product Regulation (Mouth Ulcers, GI Bleeding, Antioxidants, Adsorbents, Azodyl, Astro's CRF Oil)


Phosphorus, Calcium and Secondary Hyperparathyroidism (Calcitriol)


Miscellaneous Treatments: Stem Cell Transplants, ACE Inhibitors - Fortekor, Steroids, Kidney Transplants)


Antibiotics and Painkillers


Holistic Treatments (Including Slippery Elm Bark)


ESAs (Aranesp, Epogen etc.) for Severe Anaemia


General Health Issues in a CKD Cat: Fleas, Arthritis, Dementia, Vaccinations


Tips on Medicating Your Cat


Obtaining Supplies Cheaply in the UK, USA and Canada


Working with Your Vet and Recordkeeping


 

DIET & NUTRITION


Nutritional Requirements of CKD Cats


The B Vitamins (Including Methylcobalamin)


What to Feed (and What to Avoid)


Persuading Your Cat to Eat


Food Data Tables


USA Canned Food Data


USA Dry Food Data


USA Cat Food Manufacturers


UK Canned Food Data


UK Dry Food Data


UK Cat Food Manufacturers


2007 Food Recall USA


 

FLUID THERAPY


Intravenous Fluids


Subcutaneous Fluids


Tips on Giving Subcutaneous Fluids


How to Give Subcutaneous Fluids with a Giving Set


How to Give Subcutaneous Fluids with a Syringe


Subcutaneous Fluids - Winning Your Vet's Support


Dialysis


 

RELATED DISEASES


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Polycystic Kidney Disease (PKD)


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Home > Treatments > Working With Your Vet

 


Overview


  • Having a good vet is essential to your cat's chances of survival.

  • Ideally you want a knowledgeable, caring vet with whom you can work in partnership to give your cat the best care possible.

  • This page has tips on deciding whether your vet is the best vet to help you on your CKD journey, how to work together as a team, how to find another vet if you decide to move, and how to get a second opinion.

  • It also discusses the importance of recordkeeping.


The Importance of a Good Vet                                                                        Back to Page Index


 

If you want to be able to give your cat the best possible treatment, you need a good vet. Whilst not the only factor (it also depends upon your particular cat, how sick s/he is at diagnosis, how much s/he wants to fight, how well s/he copes with being handled etc.), a good vet can make all the difference to your cat's quality of life and chances of survival, whereas if you have to fight your vet for treatments, it is reducing your cat's chances of survival, not to mention using up your time and energy and stressing you out. This is not only my opinion: In Renal disease (2006) Dr D Polzin says "With appropriate therapy, cats with stages 2 and 3 CKD commonly survive 1 to 3 years...however, many survive much longer. A host of factors influence prognosis of CKD, both favorably and unfavorably. Included among these factors are the quality of medical care provided to the patient, the degree of interaction between the veterinarian and pet owner, and the level of owner commitment."

 

I do not wish to disparage vets, who work very hard to qualify, and most of whom genuinely love animals; but as in every other profession, some vets are good, others not so good, and a small percentage very poor. Thus it is essential that you can recognise a bad vet - your cat's life depends upon finding a good one. 

 

You need a vet with whom you can work in partnership. You do not have to like your vet, but you have to be able to communicate and work together. Even if your vet has superb diagnostic and caring skills, if your personalities clash, or if you too intimidated to ask questions, you are not a good match.

 


Working Together                                                                                                                    Back to Page Index


 

It can be hard enough finding a vet you trust and respect, but finding one who is also skilled at managing CKD is an additional challenge. This does not mean your vet is incompetent. Most general vets will be good at what they deal with most of the time. Typically, they will be seeing primarily dogs and cats, who in the main are young, usually healthy animals, for vaccinations, neutering, the occasional infection and perhaps teeth cleaning every now and then. Vets deal with multiple species and run busy practices (every vet I know works very long hours), and cannot possibly be expected to keep up with the latest research for every ailment in every species.

 

For this reason, it is not necessarily a dealbreaker if your vet is not up to speed on CKD, because as a general vet s/he simply does not have the time. What is more important is that your vet is willing to learn and is open to new information. This is where you come in. You are your cat's advocate. You know your cat best, and you can research treatments that might be suitable, ready to discuss them with your vet. This site will help you with that.

 

Your goal therefore is to find a vet who accepts that you are a partnership. Good vets are prepared to listen, to answer all your questions, to explain all the options available to you (not just the ones they favour), including the risks and benefits of those options, and to admit they don't know everything. They should be prepared to read selected research papers you bring in (though it is unreasonable to expect your vet to read a 20 page research study overnight!). They should also accept that old age is neither a disease nor a diagnosis.

 

In turn, you have to listen to your vet, who has medical training which you do not have, so you may have got the wrong end of the stick. You should be on time for appointments, pay your bills promptly (or according to an agreed payment schedule), inform your vet of every treatment you are using (some people think their vet doesn't need to know about holistic treatments, but they do) and basically try to be the kind of client you would like to have yourself.

 

Make it clear to your vet that you will listen to his/her advice, but that you also want your own views taken into account. You see your cat every day, your vet does not. Perhaps offer to make a deal regarding when you would consider letting go (see The Final Hours for more information on quality of life considerations).

 


If Your Vet Refuses To Assist                                                                         Back to Page Index


 

This is particularly common in the UK, especially for people who are trying to find a vet who will allow them to give sub-Qs to their cat, but people in other countries may also have problems. If your vet is not helpful, you need to find out why this is the case. There are two main reasons why some vets may seem to be less than helpful.

 

The first is that they think it is unfair on the cat, usually because they think there is no hope so any treatment is pointless (though in the UK, people also have trouble obtaining sub-Qs because the vet thinks they are too invasive).

 

You do need to respect your vet's knowledge and experience, and accept that it might well be true that your cat's case is hopeless. At the same time, most people also need to know they have done all they can. Treatment may not help, but not trying to treat certainly won't. As one member of Tanya's CKD Support Group put it, what adversely affects her cat's quality of life is denial of treatment. The current situation is like a snapshot in time, especially if your cat has an infection, high blood pressure or is dehydrated, and things may change dramatically with appropriate treatment. No vet has a crystal ball. Contrary to popular opinion, medicine is not black and white, there are many shades of grey, and different vets will have varying knowledge and experience which will mean they may have different opinions, sometimes even within the same practice. So your vet's opinion is just that, an opinion, albeit a professional one.

 

The second factor in a vet's approach is client expectations. Upon receiving the CKD diagnosis, many people simply assume that things are dire and the end is nigh, especially if the vet uses the term "renal failure." Even if they knew of the treatment options described on this site, they would not be willing to try them or think their cat would not tolerate them, or they (or the vet) think they cannot afford them. Since most people take this approach, your vet may assume it is also your approach unless you make it absolutely clear that this is not the case.

 

Thus, the first thing you need to do is make it clear to your vet that you wish to fight for your cat and be proactive. You also need to discuss your financial limitations, though if your vet is prepared to write you a prescription, you can often buy basic supplies cheaply online. If your vet doesn't know you very well, perhaps because your cat has always been very healthy up to now, you will also need to win your vet's trust.

 

If your vet is still not helpful or hopeful, discuss the situation and see if you can nevertheless find a way to work together. In 2012 the Royal College of Veterinary Surgeons (to which all vets practising in the UK must belong) issued a revised Professional Code of Conduct for Veterinary Surgeons which states "veterinary surgeons and veterinary nurses must accept that their own preference for a certain course of action cannot override the client's specific wishes, other than on exceptional welfare grounds." If you are in the UK, you could politely point this out and ask for your wishes to be respected.

 

It can be hard to do this, especially if you're not a particularly confident person who finds it hard to negotiate. If you ask for a treatment with which your vet is not familiar, you are taking the vet out of his/her comfort zone, especially if you utter the dreaded words "I read it on the internet." Make it easier by providing supporting documentation (I'm not a vet, so use veterinary references which I link to support what I say rather than my site itself if possible), and ask them to help you understand it. Perhaps offer to fax it over and give your vet time to digest it; this can mean less pressure for both parties than talking face to face. Remember, negotiating is not about winning. It's about reaching an arrangement that both parties are reasonably happy with. Asking to treat for two weeks before making a decision to euthanise is a reasonable compromise that many vets can accept. Also see Subcutaneous Fluids - Winning Your Vet's Support for tips on this issue in particular and how to win your vet over generally.

 

If your vet still won't help, you will need to either get a second opinion, which may help persuade your vet to work with you, or find a new vet. See below for suggestions on how to do this.

 

How to speak for Spot by Dr Nancy Kay is about how to decide which treatments would be the best choice for your dog in your particular circumstances but the principles apply to cats too.

 


Choosing a Vet                                                                                                   Back to Page Index


 

If your cat is in crisis and you simply want to find somebody who is willing to give your cat a chance, you may not have much time to shop around. If you are in the UK in particular, just finding a vet who permits sub-Qs is a bonus, and you may be prepared to move on that basis alone.

 

If you do have the luxury of picking and choosing, below are some of the factors you may wish to consider. This is how I would go about obtaining the information I require:

  • The first thing I would do is check the practice website to get a feel for the way it is run and to see if one of the vets catches your eye.

  • You can then call and speak to the receptionist or practice manager to find out basics such as cost or length of routine appointments.

  • If it seems promising, ask to speak to a vet or a vet nurse/tech with your more technical questions. Ask for just five minutes of their time, with them calling you back at a time convenient to them if necessary, and try not to exceed the time limit.

  • If you like the sound of the practice, consider making a paid for appointment to see the vet where you can discuss your cat's case and check out the facilities. You may not even need to pay for your first visit - some US chains (e.g. VCA, Banfield) often give you the first appointment free. Not everyone takes their cat to this appointment, but I figure if I'm going to see the vet anyway, it is helpful to see how the vet handles my cat.

Location


If you ever have to rush your cat to the vet in an emergency, time can be of the essence. Even for non-emergencies, it is less stressful for both you and your cat to have a vet nearby. However, it is better to travel to a more competent vet than to make do with a less competent one close by.

 

Mobile vets can be a good choice to reduce stress. As a bonus, they may see more elderly animals and therefore be relatively experienced at treating CKD.

 

Availability


You need to know both the practice hours and the vet's own hours. Some vets will only be at a practice for a day or two a week, which is not ideal if you want continuing care. If your vet is not there fulltime (and even if s/he is), ask to meet another vet at the practice so you have back up available in case of need.

 

One very important question with a CKD cat is whether you can be seen on the same day if your cat requires it. I would never use a vet who did not do this.

 

If you are in the UK, vets are obliged to provide 24/7 cover, but this will not necessarily be from your own vet's practice, so ask about that. If you are in the USA, you will often have to travel to an ER facility for out of hours cover, so clarify which facility your vet uses.

 

Cost


This matters to most of us, but ideally it should not be the defining factor. Ask how much a consultation costs, and how much standard blood tests and blood pressure checks cost. Do they charge for every little thing, or might they give you smaller items for free, such as a syringe for assist feeding. Also check hospitalisation costs - if your cat ever needs intravenous fluids, you don't want to get a nasty shock when you get the bill.

 

Can they provide CKD supplies at reasonable cost? If not, do they charge to write a prescription? This is now legal in the UK. If they do, ask if they make prescriptions valid for a year.

 

Appointments


Ascertain how long appointments last. One of my vets allocated 30 minutes to each appointment, which is obviously good. Strangely enough, he didn't charge more than other local vets whose appointments only lasted 10-20 mins.

 

Facilities and Testing


My ideal is a cat-only practice, but I've never found one that worked for me. Clarify how easy it is to park and whether it is free. Ensure the waiting room is clean and ideally with a cats only waiting area. Watch how the vet handles your cat. Ask if you can be present for basic testing. Vets do not always agree to this because there are potential liability issues if you get bitten or scratched by your own cat, even if you ask to stay, but my vet trusts me not to sue her in such circumstances. I always ask to be present for blood pressure testing in particular, because being away from me can increase my cat's blood pressure. Make sure they do not sedate all cats routinely for blood draws.

 

Promptness


Although some people care about punctuality, and this may matter if you have to get to work, it's not something that I stress over too much, because I figure that if the vet keeps me waiting because of another client, I also won't be rushed should my cat need longer on occasion.

 

What I do care about is that my vets share test results with me promptly. My vets ring me the same day that they receive specialised test results back, and have done so at 10 p.m. on occasion when something has been faxed over late at night and they know I will be worrying.

 

CKD Experience


It is worth asking how often the vet treats CKD cats and what is the usual treatment protocol. It is encouraging if the vet has experience treating CKD cats over a period of years, and can deal with complications such as anaemia, but a less experienced, open-minded vet is not a problem for me.

 

Other Experience/Referrals


You also need to know how much experience your vet has in other areas, e.g. can basic surgery be performed in house, who do they use if a cat's needs are outside their area of expertise or if they or you require additional help or a second opinion.

 

Remember, you cannot get everything you like in one vet, so decide what matters most to you. For me, having a vet who I trust who listens to my suggestions and who can see my cat quickly in an emergency is more important than the fact that she charges to write me a prescription (though I still wish she didn't!).

 

Finally - it helps, but is not essential, if your vet likes cats.

 

Special Needs Pets has useful information on choosing a vet, and on working together with him or her.  

Veterinary Partner also has helpful suggestions on finding a good vet.

Pawnation has an article about how to find the right vet.

 


A Specialist Vet or a General Vet                                                                                     Back to Page Index


If you live in a small town, you probably don't have much choice of vets. If you live in a large city or near a vet school,, you have more choices available to you. In the UK, you will usually need a referral to a specialist from your main vet, but this is not always necessary in the USA.

 

General Vets


Most of us end up using a general vet. This is not necessarily a bad thing. Although I used an ACVIM (see below) diplomate vet in the USA who was excellent, my UK vet is a general vet in the small town where I live, and she is great.

 

If you're using a general vet, you can at least try to find one who is interested in feline health. In the USA,  The American Association of Feline Practitioners lets you search for a vet in your part of the USA. These vets don't necessarily have specialist training, but they like treating cats, which is encouraging. If you use an AAFP practice, you can also point out that the AAFP recommends this website.

 

Specialist Vets in the USA


You may wish to use a vet who is an internal medicine specialist. I used such a vet in the USA. These vets have additional training, which can be very helpful when dealing with CKD. The American College of Veterinary Internal Medicine (ACVIM) has a list of its diplomates, who have undergone an additional three years specialist training. Search for a specialist in Small Animal Internal Medicine.

 

Specialist Vets in the UK


The International Cat Care gives details of feline residents which it sponsors at a number of British veterinary schools.

The Animal Health Trust in Newmarket is a specialist veterinary charity which has an excellent reputation.

Cat Professional is run by Dr Sarah Caney, a feline specialist. She offers e-mail advice to vets and will do telephone consultations with cat owners who are referred to her by their own vet. There is a fee for this service. She also runs referral clinics in Edinburgh which cost 72 if paid for in advance (tests are extra).

 

I maintain a private list of British vets who permit sub-Qs when appropriate. Most of them are not specialists, but they are open-minded about sub-Qs. If you are in the UK and need such a vet, please read here about how to obtain details of any vets in your area, though unfortunately the list is very short, so the chances of such a vet being in your area are sadly rather low.

 


A Second Opinion                                                                                              Back to Page Index


 

If you are concerned about your vet's approach, you may wish to seek a second opinion. Vet schools are a good choice if there is one in your area. In the UK, if you ask for a second opinion, your vet should be happy to refer you, but it is not always easy finding a specialist to consult, though see specialist vets above for some options.

 

Here are some options if there is no specialist near you.

 

Cornell Feline Consultation Service


Cornell University College of Veterinary Medicine Dr Louis J Camuti Memorial Feline Consultation Service is a possible alternative, no matter where you are in the world, as long as you or your vet can speak English. This service offers advice on feline health related issues. You need to provide as much information as possible (e.g. blood test results), then the consultant will contact you or your vet to discuss your cat's situation, usually within 48 hours but occasionally it takes a bit longer. The service costs US$55 and is available Mondays, Wednesdays, and Fridays, 9 a.m. - 12 p.m. and 2 p.m. - 4p.m. Eastern time (not holidays). If you are calling from outside the USA, you may have to pay for the cost of the call back from the consultant.

 

Cornell has an excellent reputation, and I have heard from several people who have used this service, and virtually all of them were very satisfied.

 

Veterinary Information Network


The Veterinary Information Network offers assistance from 250 veterinary specialists, including four nephrology consultants, to its members. Your vet can join for US$58 a month, but a 30 day free trial is also available.

 


Changing Vets                                                                                                                             Back to Page Index


 

If you feel that your current vet is not the best fit for you and your cat, you will have to change vets. See above for tips on choosing a vet.

 


Recordkeeping                                                                                                    Back to Page Index


 

It is a good idea to keep your own records, so you can monitor trends and have information readily available should you decide to move (either town or vet). It is particularly important if you are in the USA, because most people in the USA have to go to the ER if their cat is sick out of hours, and it is very helpful to the ER staff if you can provide them with records.

 

Keeping Records


However good your vet is, I strongly recommend keeping your own records of your cat's symptoms and behaviour on a daily basis, together with bloodwork results and which treatments you tried. This can help you to monitor trends, and can also serve as a reminder of what treatments worked should a symptom recur some months later. 

 

Be very sure to keep records of allergies, particularly to drugs, and make sure these are clearly marked on your cat's notes.

 

Obtaining Records


Some practices are strangely reluctant to share records. I think some of them worry that a little knowledge can be a dangerous thing (and they are right in some cases). I've also been told in the past by a vet nurse that there was no point giving me my cat's records because "you won't understand them." I must admit, that gave me a bit of a giggle. In fairness to the vet nurse, she didn't know I run this site, and what she said is probably true of most of their clients; but we can all learn what the tests mean.

 

From what I hear, if you ask the receptionist for your records, you will often be refused. If this happens, ask the vet directly, who will probably agree, especially if you are in the USA and need to visit an ER vet if your cat requires urgent help when your vet's office is closed.

 

If you continue to have trouble obtaining copies of your records, especially in cases where the clinic says the records belong to them, it may indicate that this practice is not going to be too good at treating you as a partner in your cat's care.

 

RCVS Guide to Professional Conduct requires (Clauses 13.5 and 13.6) that vets must give owners records and test results when asked to do so, although they can charge for doing so.

 

The American Veterinary Medical Association mentions that if you change vets, your previous vet is obliged to provide copies of your cat's medical records if requested (see Section VII D).

 

 

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This page last updated: 02 December 2013

Links on this page last checked: 17 April 2012